Tuesday, 2 February 2010

Functional Symptoms.......

On Monday the Oxford hospital phoned to say that they would be arranging when I can be admitted for investigations. To be honest its been playing on my mind. I really really don't like being in hospital or actually having to deal with Dr's. Since becomming ill I have experienced the duplicity of the medical profession and its not nice. It has caused me to doubt that I am ill, although the physical evidence is over whelming. It has driven me to tears and caused me to question those close to me if they believe I am ill or if its all in my head.

I don't really have a choice about being admitted. If I go, I look like an attention seeker, which we already know they think I am. If I dont go I look like I dont want to be exposed as an attention seeker. I really am in a no win situation.

I have been lucky so far in the fact that no one has actually said the dreaded C word. Which is Conversion Disorder, ( I apologise now to you M, as I promised I wouldn't talk or think about this again, but it needs to be documented here.)Conversion disorder seems to be gaining popularity again and mainly in the field of Neurology. It is a "disorder" where the patient manifests his or her emotional or mental health problems by the body manufacturing symptoms such as ptosis, paralysis,Pain, trouble speaking, trouble swallowing and even blindness. You may have heard of hysterical blindness. I know I first heard of this when on the Australian soap neighbours the character "lucy" got it when I think, (it was a long time ago) her dog Bouncer went missing. So you see the stress of the issue surrounding the dog caused Lucy to go blind temporarily.

I am not doubting that there are indeed some patients who present at a neurology outpatients department who do indeed have a physical manifestation of their stress. However this diagnosis seems to be used a lot more frequently at present. For some interesting reading find the publication ANCR Jan Feb 2005 (volume 4 issue 6). This article talks about how 33% of Neurology Outpatients have no organic disease process going on, or in Neurology speak they have "Functional Symptoms". Its quite distressing reading if you are one of those patients with "functional symptoms" as it shows you how the neurologists view you and how they use certain termanology and patterns of speech to convince you they are doing everything they can to help you.

A man called Slater did a study on patients who had been diagnosed with Conversion disorder and found that 25% of them had been misdiagnosed. With the advent of the research many years ago the label conversion disorder seemed to slip from favour. However new research has bucked this trend and now says Slater was wrong and only 4% of every patient diagnosed with conversion disorder is misdiagnosed. That 4% still equates to 4 people out of every hundred with a serious medical condition being denied treatment because some one couldn't be bothered to a)listen or b) investigate the cause of this persons condition. I still feel that the error rate is probably a lot higher. We also need to know how many patients are being diagnosed by neurologists and how many by those in the mental health field.

Too many times as I search on the internet on forums and the like I am finding people with serious medical problems being told that they are mentally ill. One heart breaking story was a mother who's 9 year old daughter had collapsed at home. The mother took her daughter to the hospital, where the daughter developed further symptoms paralysis, pain and problems swallowing. The medics carried out tests and said they couldn't find the reason why she was ill and she had Conversion disorder diagnosed by her neurologist. The mother of this child was pleading for help on a site where you can post questions and Drs answer. It had been 10 months, her child was deteriorating they had been to family therapy and individual therapy and the child had taken medications for anxiety and depression. The childs hair was now falling out and she was in horrendous pain.So much so the child couldn't be cuddled as she would cry out in pain. The Dr on the Forum told her that he would be wary of a diagnosis of Conversion Disorder given by a neurologist. He then went on to give her the names of other Drs to contact.

If other Dr's from other specialities are wary of this diagnosis being given by a neurologist, why are they still being allowed to do this? Would an oncologist give this diagnosis? Would a pulmanologist give this diagnosis?

Let me reassure you my belief is there must be some good neurologists out there that care about their patients and who will do everything they can for them. Its just I'm yet to meet one.I truly hope that one day I will meet one I haven't given up hope.

Im concerned about neurologists diagnosing illnesses/ diseases outside their own speciality.

Its not uncommon to read on forums where people have serious medical problems that on their journey to a diagnosis they had been placed on anti depressants for mental health issues that didn't exist or only came about due to the frustration of dealing with the medical profession. I have discussed this several times with friends when we have said "is it ok to get emotional at a medical appointment?" The consensus is no - don't get emotional, its seen as hysteria.Then on the flip side of the coin don't be emotional and you become accused of being detatched or not being bothered by your problems. Not being bothered by your problems is one of the "markers" for Conversion disorder,as is suffering from period pains- nope you just can't make this stuff up. Its a catch 22 situation in which a patient can not win.

To me neurology seems to be the only branch of medicine, where they seem to think they know all the answers and thinking outside the box, is not required.


Ally said...

Conversion disorder is a total, chicken**** copout. It's just one of the many nasty little things that Freud left for us woman. And I'll bet it doesn't exist. I'll bet all those women who it was based on were really sick and no one would listen to them. Just like so many of Freud's patients told him about their childhood sexual abuse. He thought about it for a while and then decided they were crazy. Well, they weren't. And anyway, there can't possibly be any proof of a conversion disorder. So how can anyone know who really, truly has it? Some psychiatrist? I don't think so. Woman have been mistreated by that field for as long as it's existed. Did you know that multiple sclerosis was considered a psychiatric illness? Ulcers too until they found the bacteria that caused it. The list goes on and on.

I think about it this way: there are millions and millions of cells in the body. Or is it billions? Anyway, it's a lot. Within and without these cells there are billions, or trillions or quadrillions or more processes going on. Just what goes on within the mitochondria is mind boggling. And yet, you can put all the diseases inside one merck manual. That's always struck me as odd. It seems more likely that there are all sorts of diseases which haven't been recorded.
What's more likely? That a neurologist can rule out every single disease, known or unknown to mankind, in the space of one or two appointments or, is he more likely to have missed one? Or, is he more likely to be presented with a more rare disease that's never been documented? Or is he more likely to be a narcissistic prick who is dismissing the miserable woman in front of him?

Also, these guys are narcissists. Here's another of my pet theories: neurologists hate to diagnose because neurologists are narcissists and hate to be proven wrong.

If a neurologist treats a person with disrespect or is dismissive or worse, sneers then that patient is more likely to put there tail between their legs and move on. That way a neurologist never has to be faced with his own ineptitude. His opinions aren't challenged. So what would you do if you were presented with a challenging, unclear case and you were a neurologist? Tell them that it's all in their heads.

I've said it before and I'll say it again. Doctors are in the only profession where they can be presented with a problem to solve - which is really everyone's job description when you think about it - and choose not to solve it. And make a fortune, at least in the US. My pulmonologist just gave me a 15 minute consult, shook his head, said basically, if you say so, when I asked him about mg. And charged my insurance company $350. Nice job if you can get it, eh?

allymacpdx said...

This is too funny! I just read this from a link that was left on one of my posts, perhaps you read it? Anyway, look at this:

"You can run any test you want on people with I.B.S., and their GI tracts look essentially normal," Dr. Mawe said. The default assumption has been that the syndrome is a psychosomatic disease.

But it turns out that irritable bowel syndrome, like depression, is at least in part a function of changes in the serotonin system. In this case, it is too much serotonin rather than too little."

Just another example. Please Rach, don't even for a second let these guys get you down. You know darn well it's not in your head!!!! If they start to talk that nonsense then kick and scream. Let them know you won't put up with it.

The Myasthenia Kid said...

Thanks Ally xx